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Attention Deficit Hyperactive Disorder (ADHD) is usually identified around the beginning of puberty and can continue into adulthood. Research shows that approximately two-thirds of those with an ADHD diagnosis also suffer from at least one other medical condition. Frequent comorbidities with ADHD are epilepsy, autism spectrum disorder (ASD), sleep issues, obsessive-compulsive disorder (OCD), Tourette’s syndrome, cognitive deficits, and anxiety disorders, among various others.

Some of these are topics for debate among professionals because of their controversy. For instance, studies show that people who have ADHD often score lower on intelligence quotient (IQ) tests compared to people without this disorder. It is possible, however, that this is due to distractibility or restlessness that comes with ADHD, and not necessarily due to lower intellectual capacity of the individuals undertaking these tests.

Sleep is a common issue among people with ADHD. Because of the symptoms and medication for ADHD, many people with this disorder experience difficulties falling asleep or staying asleep, have issues waking up in the morning, develop sleep-related breathing disorders, etc. Sleep deprivation and excessive daytime sleepiness are common results of ADHD-related sleep issues, further exacerbating the ADHD symptoms already present in an individual. However, in the other direction, sleep deprivation itself can cause very similar symptoms to those of ADHD, including hyperactivity, impulsivity, being distracted and unable to focus, not paying attention, irritability, etc. It makes it harder to differentiate between the two and diagnose ADHD in children. Persistent sleep issues often develop into sleep disorders. If not addressed, the combination of these two disorders can quickly turn into a big downwards-headed spiral, impairing all areas of a person’s life.

But let’s start from the beginning.

What is ADHD?

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, attention deficit hyperactive disorder is a neurodevelopmental mental health disorder, whose main diagnostic symptoms fall under three categories:

• Inattentiveness – Symptomatic behaviors include difficulties in organizing and keeping focus, forgetfulness, regularly making careless mistakes, failing to perform tasks that require attentiveness over a longer period, difficulties with finishing tasks, etc.
• Hyperactivity behavior examples would be excessive talking, being restless, rocking, tapping, fidgeting, not being able to sit still, being impatient and often wearing other people out by being overly-active.
• Impulsivity behaviors demonstrate very little self-control or thinking before acting, making rash, sudden decisions, etc.

This disorder first occurs before a child hits puberty and potentially continues into adulthood. Depending on the dominant symptom group that an individual with ADHD might display, they can be classified into one of the following categories:

• Predominantly inattentive type
• Predominantly hyperactive-impulsive type
• Combined type

From their names, we can gather which category matches which group of symptoms. The root cause of this disorder remains unknown, although it is believed to be connected to certain substance (like alcohol, lead, and tobacco) consumption during pregnancy, premature birth, abnormalities in the brain and genetics. Environmental and social factors have been ruled out of the question, along with high sugar intake.

Because of the nature of their symptoms, people with ADHD are prone to problematic behavior in all aspects of their lives. Compared to people without this disorder, people with ADHD have about 20% higher incidence rate for substance abuse, an over 45% higher rate for teen pregnancy, over 20% more of them repeat a grade in school and roughly 40% more get arrested at some point. Children with ADHD might get in trouble with other kids or do poorly in school; adults have difficulties cultivating and maintaining relationships, keeping jobs and regularly fall behind on their responsibilities.

How Does ADHD Affect Sleep?

As mentioned in the introduction of this article, ADHD and sleep issues often occur simultaneously, and it is no surprise since both the ADHD symptoms and medications for managing this disorder can potentially cause sleep disturbances. Half of the children who have ADHD also experience sleep issues and heightened daytime sleepiness; common issues include bedtime anxiety, sleep onset and/or maintenance problems, difficulty waking up early, and occasional parasomnias (like nightmares or sleepwalking).

Some of the most common sleep disorders affecting people with ADHD are listed here:

•  Insomnia is a sleep disorder highly prevalent in adults with ADHD, with the incidence rate of over 70%. The most commonly reported issue is with onsetting sleep; winding down can take these people over one hour before they finally fall asleep. If they don’t have this problem, people with ADHD struggle with maintaining sleep over the entire night. They wake up easily and often, sometimes have problems to fall back asleep, and their sleep is restless and less restorative. The incidence rate in children is about 50% higher than in children without ADHD.
• Obstructive sleep apnea and sleep-related breathing disorders. Sleep apnea is a breathing disorder that causes partial or total airway obstructions during sleep, causing snoring, gasping and even choking. It’s frequently developed in children with ADHD; along with other forms of breathing disorders, it strikes about one-third of all people with ADHD.
• Delayed sleep-phase syndrome is a circadian rhythm disorder that causes the timing of a person’s sleep-wake cycle to start later compared to a normal circadian cycle that’s based on the light-dark phase of the day. People with this disorder go to sleep and wake up later naturally, so if they have to adjust to a timetable that doesn’t fit their circadian rhythm, it often results in excessive daytime sleepiness and poorer performance at work or school.
• Restless legs syndrome (RLS) is a neurological disorder that causes people to, because of the sudden need or even pain, move their legs typically in periods of inactivity, often delaying sleep onset and resulting in daytime sleepiness. This problem is not so common among the general population, but over 50% of children and adults with ADHD suffer with it.
• Periodic limb movement disorder (PLMD). Similar to a phenomenon that a lot of people experience when a sudden leg jerk startles them from sleep, PLMD is a disorder that causes involuntary jerking of legs or arms during sleep that can last up to an hour at a time. It usually happens during light sleep and never during the REM-phase of sleep.

ADHD Medication and Sleep

Medication used to subside the symptoms of ADHD can be short-lasting (4-6 hours) or long-lasting (6-12 hours), and both often have an adverse effect on sleep and appetite, the latter of the two being worse. Because of the more consistent results and the ease of dosing them less frequently than the short-lasting pills, longer-lasting pills are regularly favored none the less.

Stimulant drugs and antidepressants are among the commonly used medications for ADHD; Adderall, Ritalin, Dexedrine, Aventyl, and Norpramin are some of the widely recognized drugs for treating this disorder, but they all have side-effects such as:

• Drowsiness
• Irritability
• Anxiety
• Reduced appetite
• Tics/twitching
• Elevated heart rate

Most importantly, they can all cause insomnia.

Suitable Treatments for People with ADHD and Sleep-Related Problems

The first option for a large portion of people with sleep issues or disorders is cognitive behavioral therapy (CBT). This treatment method doesn’t involve any medications in itself and can’t damage the patient no matter their sleep issue. That’s why CBT is often suggested even if it’s not certain whether a particular sleep disorder is present or not. It works by setting up a set of sleep-related “rules” to form a nighttime pattern which will minimize harmful behaviors and promote a healthy relationship with sleep. One such requirement is to avoid spending time in bed for anything barring sleep, in order to reassociate the two and shorten the time spent in attempts to relax and fall asleep.

For people with ADHD, another good treatment option is sleep restriction. It involves setting up the exact time when the patient will go to sleep and wake up every day. Whether the patient manages to fall asleep at the set time isn’t important; he/she is not to break from this schedule even if not fully rested in the morning, and additional rest is not allowed. Over time, this treatment trains the brain to prepare for sleep at bedtime, relieving sleep onset issues commonly reported among people with ADHD.

Light therapy can also be suitable for people with ADHD who have delayed sleep phase syndrome or other circadian rhythm disorders. The name of this treatment is quite explanatory; the patient uses a bright light at certain times of the day to reset or adjust the circadian rhythm, which is known to respond to light, among some other external stimuli. It helps to synchronize the patient’s sleep timing with the light-dark cycle of the day.

Sleep medication might be used to help with especially persistent sleep problems. However, these pills are not to be taken lightly, as they come with plenty of side-effects and often carry a dependency risk. Before opting for any medication, particularly if already using ADHD or some other type of medication, please make sure to discuss it carefully with a specialist.

Melatonin is a relatively safe way to achieve the sleep pill effect; it supplements the sleep-regulating hormone regularly secreted by the pineal gland in our brain. It doesn’t carry dependency risks and is preferable to sleep medication, especially for children. However, if taken in higher than the usual recommended dose (which is sometimes advised for children with ADHD), a potential side-effect is the increased risk for seizures; again, something to discuss with a doctor before taking any action. Don’t supplement without supervision!

Sleep Management Tips for Children and Adults with ADHD

• Set up a healthy routine. Take a hint from CBT and other therapy methods listed above; sleep hygiene is crucial for keeping a healthy relationship with sleep for a longer period. Set up a routine in a way that gradually relaxes you in preparation for sleep and don’t overcomplicate it – it should be easy to follow every day. Include things like brushing your teeth, using the bathroom, changing into PJs, maybe reading a book, switching off the lights and climbing into the bed to sleep.
• Make sure the way you wake up doesn’t stress you out. Instead of an annoying alarm tone, find a gentler way to ease into the day; if waking up a child with ADHD, first open the drapes and consider switching to a light-based alarm system. This will ease the irritability in the morning and set a far nicer tone for the rest of the day.
• Plan something to look forward to in the morning. Another good way to make yourself want to get up is setting up a “treat” to look forward to first thing in the morning. Maybe a breakfast prepared in advance and ready to be eaten, maybe your smartphone awaiting outside of the bedroom; even the simple act of picking out an outfit the evening before can help you dread waking up a bit less, if not put you in a good mood.
• Exercise. Important for pretty much everybody alive, exercise will help you de-stress and use up any extra energy that is stopping you from falling asleep. Also good for minimizing temper tantrums and hyperactivity symptoms that occur in a lot of people with ADHD.
• Keep it simple. Especially for children with ADHD, predictability in as many aspects of their life as possible helps avoid situations that might surprise and overstimulate them. Establishing routines that they can get used to, particularly in the afternoon and later, might make it easier for children with ADHD to settle in bed and fall asleep faster.
• Minimize your intake of stimulating substances like caffeine, alcohol,  sugar, and foods high in fat. They will either delay the sleep onset or help you fall asleep but impair the quality of your sleep, resulting in excessive daytime sleepiness and exacerbated ADHD symptoms like irritability, hyperactivity, inability to wait, inattentiveness, lack of focus, etc.

No matter one’s age, job, or hobbies, there’s often a push or drive to constantly gain new skills and knowledge. However, changes in our work or academic life, together with the demanding tasks we face, can lead to considerable stress. This stress, in turn, may cause sleep-related problems. Individuals who get ample rest are far more adept at absorbing, recalling, and processing information compared to those who are tired, quickly irritated, or struggle to focus. Considering that the most demanding and stressful jobs often require quick, impromptu learning and since academic success is increasingly prized in our society, it’s crucial to figure out how to maximize our learning capacities effectively without spending all our time working and thus, steering clear of total exhaustion.

This article aims to show the connection between healthy sleep and an increased ability to memorize information and accurately reproduce it when necessary. The idea is to create enough awareness that students and workers can plan their sleep schedule in a way that makes them the most productive, and frees up more time overall for leisure activities and personal interests. Let’s dive right in.

The Basics of Learning

In order to understand more about how sleeping interacts with our capability to learn, it’s worth breaking down learning into “components.” These components are acquisition, consolidation, and recall, in the order that they occur in. Each of these is crucial to our ability to retain knowledge, and all of them can be affected by how we sleep. We will explain them, and look at how sleeping (and sleeping problems) interact with these components to paint a clearer picture.

The acquisition is the act of finding and receiving information. It only occurs during our waking period but is still affected by how much we sleep and when we sleep. The same is true of recall, our ability to reproduce and apply the knowledge we’ve gained. Both of these can be ruined by daytime fatigue or sleepiness. Fatigue has a number of negative consequences on our mind, including but not limited to:

• A significant drop in mood. The fatigued person is often much more irritable and aggressive, and their responses to stress and other obstacles become more emotional. It can be hard to interact with them or teach them something. They are much more likely to lose focus and respond poorly to any complications.
• Memory issues and weaker information processing. Being able to interpret the information you receive properly is important if you want to truly learn something. Think about all those times you tried to memorize entire lessons in text form without understanding any of the subject matter – it isn’t reliable as a learning method because you’re not sure what’s even happening in the lesson, you’re just trying to recite definitions and go from there. Excessive fatigue can impair your memorization abilities, making it even harder to improvise that way.
• Weakened hand-eye coordination. While not a huge issue for someone studying theoretical knowledge, weakened hand-eye coordination seriously impacts people trying to learn a craft through practical work. Not only does this limit your ability to form strong muscle memory, but it also makes you more prone to potentially serious injuries.

Consolidation is a bit different. It is the only learning component that directly occurs during sleeping hours, which means the effect of our sleep quality on learning is the most obvious here. Depending on what your sleep architecture looks like and how much time you spend sleeping, the level of memory consolidation you’re experiencing can vary wildly. Certain sleep stages have the primary goal of “repairing” the mind, which includes memory consolidation, so a healthy uninterrupted sleeping session is the only satisfying scenario. Let’s look at how each sleep stage contributes when it comes to learning and memorization.

The Role of Sleep Stages in Learning

It’s not an exaggeration to claim that every sleep stage contributes at least something that helps us learn more efficiently. We’ll tackle them in order of appearance, to help you understand why you need at least a good 7 hours of uninterrupted sleep to learn old information and prepare for new knowledge.

Light Sleep and Learning

Light sleep (stage 2 specifically) is the stage that’s most often associated with memory consolidation. Around 50 percent of our total sleep time is spent in light sleep, and this number grows as the person gets older or as they catch health conditions that keep waking them up or causing fragmented sleep. It can be easy to assume that excessive time spent in stage 2 is actually beneficial to our learning because of the memory consolidation that happens in it, but it’s important to realize that other stages also make a contribution, and REM sleep, in particular, helps prepare our mind for the upcoming day. People who don’t spend enough time in deep or REM sleep often deal with considerable fatigue the following day.

Stage 2 of light sleep is characterized by a unique brainwave pattern called sleep spindles (or just spindles for convenience). These brain waves are named for how they appear on an EEG reading – a short, quick burst of low-amplitude oscillation. While spindles have not been fully “deciphered” by sleep researchers and neuroscientists yet, we have a pretty solid idea on what their purpose is. The widely accepted idea is that spindles represent a transfer of information from the hippocampus to the frontal cortex. Think of it as turning cached short-term memories into actual knowledge that’s retained for a long time. Spindles are sometimes considered a mark of intelligence, as connections have been made between spindle production frequency and the person’s performance IQ. Additionally, older people tend to have slowed down spindle production, which can explain some of the adverse effects that aging has on a person’s mind.

Light sleep is so effective in helping you learn new information that people often recommend taking short naps to consolidate things you’re trying to learn. Much like the REM stage, light sleep plays a (smaller but still relevant) role in preparing the brain to handle new information, which is why we often come up with solutions to problems after “sleeping on it,” hence the expression. Oddly enough, sleeping helps us more when it comes to solving harder problems than easier ones.

Deep Sleep and Learning

Deep sleep (otherwise known as sleep stage 3) has repeatedly been shown to increase our ability to consolidate declarative memory. Declarative memory (otherwise known as explicit memory) is a conscious, intentional, internal recollection of concepts, factual knowledge, and various experiences. As you may have guessed from that description, this is mainly important for school and university students, since this type of memory is directly associated with remembering concrete facts. The more deep sleep a person experiences regularly, the higher their chances of remembering something crucial when it counts, such as on a test.

Stage 3 is critical for our ability to learn higher-order, more abstract concepts. This learning process is much more taxing on our brain, as we’re not just memorizing simple concepts and facts. Examples of higher-order thinking include the ability to analyze, think critically (very important for improving at almost any skill the person wishes to learn), evaluate and synthesize (which is how new knowledge is formed). Seniors regularly spend much less time in deep sleep than they should, as fragmented sleep is one of the main symptoms of age. As a result, they find it much harder to learn new information, especially abstract concepts.

REM Sleep and Learning

REM sleep (or stage 4, as it’s also known) is the sleep stage where vivid dreaming takes place. One of the many theories about the purpose of dreaming claims that dreams help us replay memories or invented scenarios in our head while sleeping, to help us reinforce our knowledge and prepare for risky situations. Think of it as a subconscious mental exercise for the near future. This idea may explain why we often dream about things that happened the previous way, although usually indirectly. Because of this memory replay function, REM sleep is considered crucial for solidifying recently acquired knowledge, even without considering all the other mental benefits of this sleep stage.

Stage 4 is also responsible for abstraction – a core information processing technique. Have you ever used a mind map (or mental map)? It is a manually-drawn network of information that helps the person making it memorize a whole bunch of information without having to painstakingly recite the definitions and sentences for hours. The idea is that any new information you get can be assimilated into this more abstract environment, and connected with other relevant pieces of information. Our ability to connect pieces of information that we got at separate moments and that we originally associated with separate concepts is a key part of our intelligence as humans.

Sleep and Bad Student Habits

Being a student can be rough, especially for college-aged students. Exam deadlines are always looming over your head; some professors are simply not good at teaching; some textbooks are written in an unintuitive and over complicated way – we’ve all been there. Because of this hectic schedule, a lot of students naturally develop bad habits without noticing them. However, those habits could be ruining their sleep, and therefore their ability to learn efficiently and deal with those exams. Here’s a brief list of behaviors students resort to when they’re under academic pressure, no matter who it’s coming from (parents, teachers, peers, etc.):

• Pulling all-nighters. While a night spent studying is often considered an emergency, last resort method of flash-studying before a scary exam, it offers very little tangible benefit. Not only is sleep necessary for proper learning, but the process can also often take multiple nights, which makes the odds of actually remembering a lot of the information you read during an all-nighter incredibly small. Besides, the need to sacrifice that much sleeping time to “catch up” on all the schoolwork you have in your backlog is often a sign of underdeveloped work habits and lifestyle problems. Give yourself ample time to prepare for an exam so you can sleep properly and be more productive.
• Drinking excessive amounts of coffee. While this applies to other stimulants and substances as well, coffee is the main offender in this context. This habit goes hand-in-hand with the abovementioned all-nighters because the student needs some way of staying awake through that much-missed sleep. However, this habit directly hurts their ability to rest the following night, creating a horrible cycle of fatigue and sleeping problems that can not only cause their grades to drop but also damage their health. Tea is equally risky if consumed in large amounts, and it’s also a part of youth culture as a staple drink. Heavy sugar consumption and other dietary issues do nothing to eliminate fatigue during the day or assist in healthier sleep.
• Partying too hard or too often. This point mostly boils down to alcohol use, as alcohol has a huge amount of negative effects on the body. Every college-age student is well-aware of hangover symptoms that can ruin not just an exam, but an entire day’s worth of concentration and attention. On top of that, alcohol can disrupt melatonin production, reducing it by around 20 percent after only a moderate dose. Sadly, alcohol consumption, in general, is one of the most common measures students (and working adults, let’s be honest) take to deal with stress and anxiety. It’s doing them a lot more harm than good.

The diagnosis of sleep-related issues and disturbances is dependent on a variety of methods, encompassing clinical questionnaires, interviews, physical examinations, and studies conducted in sleep laboratories. Presently, a wide range of guides and manuals are available to doctors, assisting them in identifying various symptoms and linking them to particular sleep disorders.

Even so, diagnosing disorders can be tricky. Many of them have overlapping symptoms amongst one another, conditions for diagnosing are less than ideal, not to mention the tendency of general practitioners and experts in different fields to assume that certain sleep disorders are symptoms of other medical conditions, rather than disorders on their own. In fact, a survey done in 1991 involved 37 American medical schools stated that sleep and sleeping disorders were covered on average for one or two hours in total; the perfect picture of where we stand when it comes to sleeping science.

The first book on the subject was released in 1850, written by Robert MacNish. It mentioned sleepwalking, sleep-talking, nightmares and sleeplessness. Fast-forward to 1924, Electroencephalography (EEG) was discovered, shortly followed by many other landmark discoveries (REM sleep and sleep apnea amongst others), shaping sleep science as we know it today. It allowed for a better understanding of many sleep disorders already known and discovering of new, unexplored ones. A few attempts have been made at organizing and differentiating between this mess of new information.

At this point, three organizational systems are largely at use around the world:

–          the International Classification of Diseases (ICD), written by the World Health Organization (WHO)

A “standard diagnostic tool for epidemiology, health management, and clinical purposes,” the ICD classifies a wide array of diseases and pins them to corresponding generic categories (including some sleep disorders) while pointing out possible variations and common complaints with patients. This “general rule of thumb” of the classification manuals is a good reference point for purposes of general practitioners and specialists alike.

–          the Diagnostic and Statistical Manual (DSM), developed by the American Psychiatric Association (APA)

This manual is mainly made for use by mental health professionals and general practitioners. A common mental health disorder guide, it also covers general health, including sleep-related issues, although not in such detail as the ICSD.

–          the International Classification of Sleep Disorders (ICSD)-3, by the American Academy of Sleep Medicine (AASM), intended for sleep specialists.

Universally followed by sleep specialists and researchers, this manual finally provides the in-detail, distinctive approach to sleep medicine that previously lacked in the healthcare system. It is this system that we will break down in more detail below, from its first version in 1979 to the advanced last one that is used presently, along with some established diagnosis and treatment strategies used by doctors around the world.

Evolution of the currently used classification system

The first extensive classification of sleep disorders, intended for sleep specialists and general practitioners of medicine, called Diagnostic Classification of Sleep and Arousal Disorders (DCSAD), outed in 1979. It grouped disorders based on their symptoms and formed the basis of the classification system still used today. Although the manual helps to understand the basic approach to diagnosing sleeping disorders, back then, due to the limitations of research methods, the causes of many sleeping disorders were still largely unknown. Because of this problem, a new manual, called International Classification of Sleep Disorders (ICSD), was published in 1990 through the combined efforts of American Academy of Sleep Medicine (AASM), European Sleep Research Society, Latin American Sleep Society and the Japanese Society of Sleep Research. This edition updated and resolved many of the first edition’s misconceptions and was a huge success. The next edition, ICDS-2, only minorly edited and improved the ICDS from 1990, and was published in 2005. Finally, the latest revision, the ICDS-3, outed in 2014 and remains the most authoritative clinical manual for diagnostic of sleep disorders to date.

Diagnostic Classification of Sleep and Arousal Disorders (DCSAD)

The first diagnostic manual was written by the Association of Sleep Disorders Centers (ASDC), in collaboration with the Association for the Psychophysiological Study of Sleep. In this manual, sleeping disorders were placed into three symptom-based groups:

–          Disorder of initiating and maintaining sleep (DIMS)  – Insomnias

–          Disorder of Excessive sleep (DOES) – Hypersomnias

–          Parasomnias

Due to the sudden and significant growth in the field, sleep specialists were able to reevaluate and expand the previous grasp of sleeping disorders, so a revision of the first classification system was necessary.

International Classification of Sleep Disorders (ICSD)

This adjusted edition of the first manual was, at the time, very useful for differential diagnosis of the disorders, introducing the previously lacking pathophysiological aspect into the picture – it acknowledged the possibilities of association between sleep disorders and other conditions, like mental, neurological and other medical disorders.

International Classification of Sleep Disorders (ICDS)-2

In 2005 came out the minorly improved, redone edition of the ICDS. It listed eight categories consisting of a total of 81 sleep disorders, with their symptoms described in detail and including precise, distinctive diagnostic criteria. Additionally, it presented other notable issues like the diagnosis of sleep disorders connected to non-sleep disorders and stated some psychiatric disorders that frequently come hand in hand with certain sleep disorders.

The categories listed were as following:

1.The insomnias, including adjustment sleep disorder (acute insomnia), psychophysiological insomnia, paradoxical insomnia (formerly sleep state misperception) and seven others;

2.The sleep-related breathing disorders, with five subgroups and a total of fourteen disorders;

3.The hypersomnias of central origin, consisting of twelve disorders;

4.The circadian rhythm sleep disorders, nine disorders, including jet-lag type, advanced sleep phase type, delayed sleep phase type, etc;

5.The parasomnias, with three subgroups: Disorders of arousal (from non-REM sleep), Parasomnias usually associated with REM sleep and Other parasomnias;

6.The sleep-related movement disorders, covering eight disorders;

7.Isolated symptoms,unresolved issues, and apparently normal variants such as long sleep, short sleep, snoring, sleep-talking and five more;

8.Other sleep disorders, with three different disorders

International Classification of Sleep Disorders (ICSD)-3

Published in 2014, the latest revision of the dominant classification method cleared up some issues and disagreements that the international sleep specialist society brought up in the last decade. This version categorizes sleep disorders into six respective categories:

• Insomnia
• Sleep-Related Breathing Disorders
• Central Disorders of Hypersomnolence
• Circadian Rhythm Sleep-Wake Disorders
• Parasomnias
• Sleep-Related Movement Disorders

Some of the changes made comparing to the ICDS-2 include separating narcolepsy into two types and changing the criteria for grouping disorders from symptom-based to pathophysiology-based.

Methods commonly used for diagnosing sleep disorders

The first step to every diagnosis is carefully taking the patient’s medical history (noting all previously or currently used medication, possible past diagnosis, and attempts at treatment), considering patient’s age and current health state, and being open to the possibility of another condition – it is important to determine whether a sleep-related symptom or disorder is secondary to a psychiatric condition if there is one, and vice versa. These distinctions greatly influence any future treatment plans.

A sleep log maintained by the patient for a minimum of two consecutive weeks may help measure the type and level of disturbances in a normal environment, although with the obvious flaw of being subjective. A parallel diary by a partner might also be useful.

The Epworth Sleepiness Scale (ESS) is a tool used to determine daytime sleepiness levels, useful for keeping track of therapy progress.

An actigraph might be used for a few weeks. It’s a motion-sensing tool that helps with sleep-wake cycle evaluation and regularly complements sleep journals. It is also recommended in case a polysomnography test isn’t available or necessary for the diagnosis.

Polysomnography is a multi-parametric test used to confirm or rule out sleep apnea and some other disorders. It is performed in a laboratory at a time when the patient would usually sleep at home; it monitors sleep stages and respiration, showing EEG (electroencephalogram), EOG (electrooculogram), ECG (electrocardiogram), movements of patient’s chest, legs, airflow (nasal and oral) and blood oxygen levels in the body.

A Multiple Sleep Latency Test (MSLT) is a test usually following after a polysomnogram, with all its equipment still positioned as they were during the night. MSLT is used to measure daytime sleepiness; the patient is held during the whole day and offered to nap every other hour. When that happens, MSLT measures how quickly the patient falls asleep, and whether or not the REM stage was present during the nap, which would be a sign of narcolepsy.

Possible treatment plans for different conditions

It is imperative that a doctor determines whether the patient’s disordered sleep is primary or secondary to another medical condition. When it is secondary, diagnosis and treatment of the root problem is the first line of action; treatment of the sleep disorder at the same time as the primary condition might be required.

In situations where a diagnosis isn’t definitive, the first line of action is usually consisting of a good sleep hygiene plan and potentially implementing cognitive behavioral therapy (CBT). These methods are pill-free and can’t hurt. CBT consists of methods aiming to relax the patient, help them learn to associate the bed with sleep, limit their time in bed to nighttime and deal with any issues or questions they have about sleep.

For narcolepsy, idiopathic hypersomnia, acute insomnia, certain parasomnias, and some other conditions, pharmacotherapy is necessary and effective.

Various Continuous Positive Airway Pressure (CPAP) devices are indicated for nightly, at-home use for sleep apnea and other sleep-related breathing disorders, ensuring the airways remain open during sleep. In more severe cases, surgery might be required.

Carefully timed bright light and darkness therapy, accompanied by a supplement of melatonin, effectively treats chronic circadian rhythm disorders (delayed sleep onset being the most frequently faced). Two other universally suggested strategies for circadian rhythm disorders include stimulants, and Chronotherapy, which works by moving the patient’s time for sleep and waking up by a little bit every day until they reach a normal bedtime hour. In case the patient decides to accept and schedule their activities around the delayed sleep onset disorder, treatment isn’t needed. The proof of the diagnosis is enough to help the patient avoid having scheduled appointments and responsibilities in their specific bedtime.

But what about children?

Studies done on the subject reveal that from 25%, up to 50% of children experience sleep-related problems during their childhood. Disordered sleeping is linked to behavioral concerns, and more common in children and adolescents with other chronic issues like psychiatric, medical or neurodevelopmental conditions.

There is a number of sleep disorders known to be prevalent in children:

• Obstructive sleep apnea
• Sleepwalking
• Confusional arousals
• Nightmares
• Behavioral insomnia of childhood
• Restless leg syndrome
• Delayed sleep phase disorder

When diagnosing children, doctors need to keep in mind that their normal sleeping patterns aren’t the same as those in adults, along with their expected physical and developmental stages through childhood. Pediatric obstructive sleep apnea is the most alarming disorder when it comes to children. Immediate treatment is required; other disordered sleep experiences, although maybe scary to the child, often resolve on their own, or with a little support of improved sleep hygiene.

The classification system of sleep disorders in children isn’t often encountered in the form of a separate manual; sleeping disorders are rather included in general practitioners’ and pediatricians’ guides, but many websites and articles offer a wide palette of information to help doctors recognize and treat any potential sleep issue in children.

Sleep is like a delicate dance, easily tripped up by the smallest misstep. Imagine, you’re big on getting those Z’s, but sip on one more coffee than usual, and bam! You’re dragging yourself through the day, tired and out of sorts. Truth be told, a lot of folks don’t give their shut-eye the VIP treatment it deserves, letting bad habits sneak in and mess with their snooze quality. It doesn’t take a full-blown sleep disorder to knock your internal clock out of whack, messing with your wellbeing and how well your body fights off germs. But, talking big sleep troubles, trauma stands out as a heavyweight disruptor. Stick around, and you’ll find out why tackling this can turn those nighttime wobbles into smooth sailing.

The word trauma often refers to the damage caused by any physically or emotionally harmful experience. Sources of potential trauma are way more common than anyone would reasonably expect, which unfortunately means a lot of people have sleeping problems or other health issues as a direct consequence of whatever hardships they’ve endured. In this article, our goal is to present information on the many ways that people can experience trauma, as well as how that affects their sleep and subsequent health situation. That way, some readers with sleeping problems might be able to recall a traumatic event that has led them to this issue, which can help them seek proper therapy. Let’s get into it.

The Many Sources of Trauma

There are two main kinds of trauma – physical trauma and psychological trauma. Physical trauma occurs as a result of physical injuries. While the phrase can adequately be used to describe mild injuries, it’s most commonly used to refer to serious ones – injuries that come with a state of shock, breathing failures or even death, in the worst case scenario. On the other hand, the term “psychological trauma” refers to emotional damage caused by highly distressing events and experiences. When people use the word “trauma,” they refer to psychological trauma in most situations.

Both types of trauma can be encountered in many different scenarios, with some particularly threatening and horrific situations being able to cause both physical and psychological trauma at once. Traumatic events can happen out of nowhere, which makes them difficult or impossible to prepare for. In the context of psychological trauma, there are scenarios that people think about in advance and mentally brace themselves for – and then get seriously affected by anyway. Let’s look at a list of some common traumatic experiences, to showcase how common this phenomenon can be:

• Physical, emotional, verbal or sexual abuse. This one is a no-brainer, but the scary part is that it’s often hard to break out of. Many cases of abuse happen over a period of time, which exacerbates the traumatic aspect even further.
• Physical assault or sexual assault (especially rape). Many victims or physical or (especially) sexual assault develop a fear of other people, on top of other health-related issues.
• The death of a close friend, partner or family member. This emotional damage can be amplified if you directly witness them pass away. Grief can be incredibly hard to deal with, to the point of being life-changing.
• Experiencing combat while deployed in the army. There is a reason the phrase “post-traumatic stress disorder” is so commonly associated with war veterans. War can tear families and friends apart, which is a horrific experience for everyone involved, but being in combat is especially traumatic.
• Being in an accident, usually on the road or at work, can cause both physical and emotional trauma quite easily.
• Natural disasters. Multiple potentially traumatic events can occur during a natural disaster, including (but not limited to) injuries, the death of loved ones, massive property damage and so on.
• Being afflicted with a serious disease or similarly crippling condition (such as losing a limb). It is very easy to spiral into mental issues and believe your life is ruined. Most diseases are inherently physical but have considerable mental and emotional consequences as well.
• Seeing severe harm come to other people (even strangers). Public muggings, beatings or shootings have a high chance of causing some psychological trauma.

Traumatic Brain Injury (TBI) and Its Effects on Sleep

TBIs happen as a result of a violent and traumatic injury, primarily to their body or head. This trauma can be roughly anything that severely shakes up the head and body, with the most severe cases often including a physical object entering the brain tissue. Example causes include car accidents, violence (including military combat) or even sports activities. It is important to differentiate between mild TBI and moderate or severe TBI, as the consequences and symptoms differ wildly between the two. Most cases of TBI (around 80% to be specific) are mild, thankfully. Still, the CDC estimates that around 50,000 people die each year from traumatic brain injury.

Mild TBI can have a plethora of possible symptoms, including a temporary loss of consciousness, difficulty speaking, nausea (with frequent vomiting), dizziness, headaches, sensitivity to sound or light, mood swings, anxiety, depression, and sleep problems. These symptoms typically kick in a couple of days after the traumatic event, and last several weeks, at worst. However, moderate and severe TBI is much worse. Every symptom that you experience with mild TBI gets much worse, and additional (and horrific) symptoms are added on top. These symptoms include a much higher difficulty waking up from sleep, coma, seizures, increased aggression, and clear fluid drainage from the nose or ears. Any symptoms of moderate or severe TBI will appear sooner than those of mild TBI. As for causes, you’re looking at a list that includes falls (which are considered responsible for 47% of all TBI cases), being struck by an object (through accidents, violence or self-harm), military combat and vehicle accidents.

As TBIs happen due to physical injuries, the resulting pain and discomfort are obviously capable of disrupting sleep. It has been estimated that around 60% of all TBI patients experience difficulties falling or staying asleep. It’s easy to see why, as the brain is where our circadian rhythm is regulated, so direct injuries to it are almost guaranteed to disrupt our biorhythm and cause other complications. In particular, people who suffer from TBIs can expect to tangle with one or more of the following sleep disorders:

• Insomnia, one of the most common and well-known sleeping disorders. People who suffer from this condition have trouble falling or staying asleep, and experience a lot of fatigue during the day. Insomnia has a habit of destroying a person’s sleep cycles, which weakens their immune system and makes them more susceptible to other health conditions.
• Delayed sleep-phase syndrome, a condition that often comes with a dysfunctional circadian rhythm. Most commonly, this syndrome makes the person very alert in the evening, as they become sleepy much later than normal, usually during morning hours.
• Narcolepsy, a condition that creates an almost irresistible urge to fall asleep at random points during the day, no matter how tired the person is or what time of day it is.
• Sleep apnea, a disorder that causes a temporary loss of breath at night. Two types are generally diagnosed – obstructive sleep apnea and central sleep apnea – and they have slightly different treatment methods.
• Sleepwalking, a parasomnia that is characterized by abnormal behaviors during sleep. Typically the person gets out of bed at night and wanders around, risking injury and other problems.
• Sleep-related movement disorders like bruxism, restless legs syndrome (RLS) or periodic limb movement disorder (PLMD).

PTSD and Its Effects on Sleep

Post-traumatic stress disorder (or PTSD for short) is a very common condition affecting those who have experienced trauma in the past. It typically occurs within a three-month period after experiencing the traumatic event and is “announced” by intense feelings (and symptoms) of anxiety. Not everyone that goes through trauma will have to deal with PTSD, but the odds don’t look great. PTSD was “discovered” during World War I when deeply troubled soldiers were examined – at that time, this condition was called shell shock.

Two types of PTSD exist – acute (another word for “short-term”) and chronic (long-term). Acute PTSD, while harmful and crippling, typically succumbs to treatment over the course of six months or so. On the other hand, chronic PTSD is much harder to treat, often taking years – and unfortunately, sometimes the patient never fully recovers from this condition. For someone to be diagnosed with PTSD, they have to experience all of the following symptoms for as long as a month:

• Avoidance: The person with potential PTSD will avoid some element of what they experienced. For example, someone that has been injured in a car accident may refuse to drive or ride in a car most of the time.
• Re-experiencing event: At some point, the person will mentally re-enact the traumatic event, usually through what is known as a flashback; others may have recurring nightmares or generally disturbing and unpleasant thoughts. This symptom is usually “triggered” by a specific phrase that reminds them of the trauma.
• At least two mood or cognition symptoms. These symptoms may include the person having trouble remembering the exact details of the traumatic event, blaming themselves for what happened, self-loathing and dissociation from their loved ones and activities they once enjoyed.
• At least two reactivity and arousal symptoms. The person may be easy to upset or startle, or they might run into sleeping problems. They could also suddenly lash out at others out of panic. Unlike re-experiencing events, the person doesn’t need a subtle reminder to experience this symptom.

When it comes to how PTSD affects sleep, you can expect to encounter many of the same sleep disorders and syndromes that affect TBI patients. These include narcolepsy, insomnia, delayed sleep-phase syndrome, sleepwalking, obstructive sleep apnea, bruxism, RLS, and PLMD. However, the psychological damage associated with PTSD also manifests itself in a couple of unique ways. For example:

• Frequent and vivid nightmares. As people who suffer from PTSD are often forced to involuntarily re-enact the traumatic event in their minds, it should come as no surprise that they have to deal with nightmares. In fact, nightmares are used to help diagnose PTSD. Not every bad dream will be a re-enactment, but the presence of strong negative impulses such as fear or anxiety tends to remain, even if it’s more symbolically.
• Parasomnias. While sleepwalking occurs for both TBI and PTSD patients, PTSD is often accompanied by other parasomnias, such as night terrors, sleep talking, night sweats and irrational fears. The most notable condition in this context is REM sleep behavior disorder. This condition forces the person to physically act out their dreams, which can be quite disastrous for someone with PTSD.

Treatment Methods for Trauma-Related Sleeping Problems

Due to the nature of TBIs and PTSD, any side-effects that come with prescription and over-the-counter medication could be extremely harmful to multiple aspects of your health. As a result, people dealing with trauma often seek out drug-free therapy methods, which includes:

• Cognitive behavioral therapy (CBT), an increasingly popular treatment method for a variety of sleeping disorders and conditions. This approach relies on the patient’s ability to track their sleeping patterns to produce information that helps the therapists and sleep specialists in offering good advice. A lot of techniques that fall under this category try to affect how the patient treats sleep in their mind and change any misconceptions they have. The result of effective CBT can reduce sleep onset latency by as much as 45 minutes, and improve the amount of time you spend asleep by 30-60 minutes.
• Light therapy (also known as phototherapy) is an approach used to treat TBI patients by fixing or stabilizing their circadian rhythm. TBI patients almost always have disrupted circadian rhythms, and light therapy helps by stimulating the photoreceptors that tell their master biological clock (located within the brain) when it should secrete proper sleep-related hormones.
• CPAP or BiPAP therapy is mandatory for TBI or PTSD-affected patients who suffer from sleep apnea as a consequence of the trauma. This non-drug method uses an airflow generator to pump pressurized, humidified air straight into the person’s nose and mouth to help bypass airway blockages in their throat.
• Exposure techniques can help patients with PTSD. This method boils down to a re-creation of the traumatic event (or something close to it, usually), which forces the patient to face their fears and anxieties head-on. Prolonged exposure therapy can have a massive positive effect, as the person becomes largely de-sensitized to the negative effects and feelings associated with the event.
• Acupuncture has been showing promise as a treatment method specialized towards TBI patients. While researchers don’t necessarily agree on everything about acupuncture, results show that it could help improve sleep quality, as well as remove negative misconceptions about sleep.

In our current era, the use of fear tactics to give out medical recommendations is becoming ever more prevalent. Alerts regarding health risks presented in the media have become as exaggerated as the latest celebrity scandals, complete with alarming warnings about certain dietary components allegedly causing cancer or other serious health problems. The difficulty in interpreting such warnings often stems from political agendas, which usually aim at discrediting a particular food producer or a similar entity. Nonetheless, considerable health dangers and their repercussions are still being ignored by the greater population.

Many studies have shown that short sleepers (people who get less than 7 hours of sleep each night) and long sleepers (people who sleep for more than 8 hours per night) face an increased risk of early death. If you look at the mortality rate chart shown in many of these studies, you will notice a repeating U-shaped pattern that spells it all out for you. In this article, we will look into these studies and examine the risk factors that can contribute to this early death statistic. This information will be able to help you plan your sleep schedule and general lifestyle to improve long-term health.

Note: Don’t be scared into thinking that short and long sleeping put you in guaranteed danger. Your medical history and individual physiological quirks, as well as your environment, are much more important factors to consider over whether you should be asleep for 7 or 8 hours. If you’re concerned, speak to your primary care physician.

The Concept of Relative Risk

Relative risk or risk ratio (both are abbreviated as RR, thankfully) is an epidemiological term used to describe probability. Epidemiology is the term for scientific analysis of studies and data, specifically related to the distribution and determinants of diseases and other health conditions in various populations. Epidemiologists try to narrow down specific risky behaviors that increase the chances of disease and other issues. The way the resulting information is presented may look convoluted and unintuitive at first, but it’s quite sensible. Let’s look at an example unrelated to sleeping:

You take two groups of people at a dinner event. One group is composed of vegetarians who avoid the steak portion of the buffet. The other group freely indulges in this steak dish. Thirty people eat steak, and 15 of those experience illness and nausea. Twenty people eat only the vegetable portion of the meal, and only 3 of them get ill. The relative risk ratio for the steak lovers is 0.5, while the vegetarians are facing a relative risk of 0.15. It means that people who ate steak were more than three times more likely to experience nausea compared to vegetarians. It points to the assumption that steak was the main cause of illness at the dinner event, although it cannot be considered irrefutable proof.

Separate potential factors can become “confounding factors,” meaning that they influence both the suspected cause and the outcome, which can muddy the research results and cause inaccuracies. Confounding factors and determinants are isolated and controlled through methods like stratification – sampling various subpopulations within the target population to find only the most relevant common factors.

In the context of sleep disorders or today’s specific topic (early death as a result of long or short sleeping), there is a list of common determinants to work with. If you’ve been reading any articles about sleep disorders, you can probably name a good handful of factors – stress, alcohol consumption, dietary habits, medical history, levels of exercise, etc. In this article, we’re looking at short and long sleeping as a possible factor that contributes to early death.

Study Results

The association between sleep duration and overall mortality has been shown in over 20 studies to this day. They all present the familiar U-shape pattern centered around the 7h sleep duration mark. While the mortality risk of regular sleepers is 1, short sleepers bump it up to 1.1, and long sleepers have a mortality risk of 1.23. However, it isn’t enough information to base a conclusion on, and the direct causes of those deaths should be examined. Sleep disorders are not considered a cause of death, but the weakened immune system you get can cause dangerous and potentially lethal health problems.

Let’s look at cancer and cardiovascular disease; two very common causes of death in the United States. Short sleepers have a relative risk of 0.99 when it comes to dying of cancer, meaning they’re only a tiny bit less likely to meet that end than normal sleepers. However, their relative risk of dying of cardiovascular disease is 1.06, a noticeable notch above average. Long sleepers have it the worst when it comes to these two conditions – their risk ratio for death by cancer is 1.21, and they have a relative risk of 1.38 for cardiovascular disease-related death.

Studies that deal with this sort of topic often function as a long-term monitoring process with questionnaires that get filled in by the subjects (often pairs of twins for convenience) each year or every couple of years. Because a lot of contributing factors for early death may exist in their lives, extra questions are included about their daily or weekly habits – things such as alcohol consumption, diets, levels of exercise, tobacco smoking, the presence of sleeping medication or any other significant drug that can influence the findings. Most studies tend to focus on cancer and cardiovascular disease.

The Allostatic Load Theory

The idea of the allostatic load has not exactly been widely accepted by the academic and medical circles thus far. However, it could be a key factor in explaining why abnormal sleep leads to increased mortality. The way it works is easy to understand on a basic level – allostasis is the process of achieving homeostasis. Homeostasis is a stable state of internal chemical distribution, and it is necessary for our body to function properly. A simple example is body temperature, where your body stops functioning properly if you go even slightly higher than the regular value.

The allostatic load is essentially the combined “wear and tear” your body experiences as it is exposed to chronic or repeated stress. Your nervous system responds to this stress in an intensified or fluctuating way, which has negative physiological consequences. Individual systems within the body respond to the overall state of the body, and the brain anticipates your needs and regulates the release of hormones and the processing of stimuli in advance to compensate. However, if the issue remains unresolved, the brain will continue pumping an increased amount of hormones, which isn’t healthy. One of these issues is sleep deprivation, and this idea goes a long way towards explaining why short sleepers have an increased mortality risk. Allostatic load is considered a key factor in many diseases and problems that a majority of seniors face. The longer a person is alive, the more wear and tear their body experiences, leading to health issues.

You’ll notice that most of this applies primarily to short sleepers. There is a different potential explanation for the increased mortality risk of long sleepers. The idea is that long sleep is most likely caused by one of a large number of potential underlying conditions. The fatigue that various illnesses cause can increase the amount of time a person spends asleep, and while the long sleep itself won’t be the cause of death, it is a warning sign that something much more dangerous (and likely undiagnosed) is happening under the surface. If the long sleep is diagnosed as hypersomnia, then the other conditions are considered co-morbid – meaning that they coexist with this sleeping disorder.

Changing Your Sleep Patterns

The idea of early death and mortality risks could cause some people reading this to get worried. After all, if someone is health-conscious and avoids harmful foods, then it is only natural that they would try to change their sleep schedule. However, it can be complicated to suddenly move your entire sleeping window to another part of the day, or force yourself to sleep more or less than what you’re used to. That’s why we recommend a series of steps you can take to fix your schedule without disrupting your normal daily routine and performance:

• Before attempting to make any sort of big changes to your lifestyle, keep a sleep journal for a couple of weeks. Sleep tracking is an excellent way to become more aware of how much sleep you’re getting, and get other relevant information. Try to keep this journal for a while even after you make alterations to your sleeping schedule, since the information may be useful later on.
• Consult your doctor about your plan. This step seems like a no-brainer, but so many people try things recklessly and get ill as a consequence. If your journal makes you suspect you have a sleeping disorder that’s causing you to sleep for more or less time than is ideal (which is 7-8 hours in this case), give them the journal, so they know what you’re dealing with. If they suggest a polysomnography session or other similar diagnostic tests, agree to them, since it’s crucial to know how you normally sleep and whether you’re dealing with a condition. Follow their diet advice or exercise recommendations, as these routines will help you live healthy even if they don’t directly affect sleep.
• Use an alarm or similar device to wake up exactly when you need to. Even if you’re unemployed or otherwise free to wake up at any time you want, investing in a smart alarm or a special lamp is a good idea. These alarms and lamps wake you up without instantly shocking you out of deeper sleep, usually through sleep stage detection or by slowly increasing the light in your room to emulate sunrise. Your circadian rhythm is governed by an internal biological clock that responds to light levels around you, so these lamps can help you feel refreshed when you get up.
• Manage your daytime naps. Short sleepers are sometimes tempted to take a quick daytime nap to “freshen up,” but this can disrupt their sleep schedule and do more harm than good. It’s good to be very tired before you hit the sack, as it can help you sleep for longer.

Chronic insomnia is extremely prevalent, with about 30% of the general population being affected. Struggling with sleep issues doesn’t automatically mean you should reach for medication, especially those over-the-counter types without consulting a professional! Insomnia can be quite disruptive and exhausting, even in milder cases. Should you find yourself dealing with its symptoms, it’s essential to seek advice from a healthcare professional before embarking on any treatment plan.

Things to Try Before Opting for Sleeping Pills

Before opting for pills, you should always try some less-invasive alternatives, such as natural sleep aids or CBT-I.  

When it comes to Cognitive Behavioral Therapy, this method of treating insomnia doesn’t involve any medications and instead focuses on improving your sleep hygiene and general wellbeing by reducing stress, setting up a sleeping schedule, etc.

If these still didn’t provide you with the so much wanted relief from insomnia (and you also tried other common-sense methods like limiting processed foods, caffeine and alcohol intake and getting more physically active) it might be time to look into sleep drugs and prescription medicine.

What Your Doctor Should Consider

When considering sleeping medication (or any medication really) for the first time, it is important to know exactly how it works and what are the possible side effects and complications for your health.  Before going into different drug options, your doctor will ask you some general questions to determine which course of action is appropriate for you. These will typically cover your medical history, age, sleeping hygiene, allergies and any other medication you might be taking.

After that, he or she will move on to your insomnia symptoms. In case your insomnia is secondary (caused by another medical condition), you will need to address the underlying condition.

It’s also important to determine whether you have issues with falling asleep (sleep onset insomnia) or staying asleep (sleep maintenance insomnia), as different medications target different problems.

Finally, your doctor should be able to prescribe a medication that potentially fits your needs, and schedule an appropriate follow-up, as most medications are meant for short-term use only. In case the first drug doesn’t work for you in the previously established period, make sure to report back to your doctor so he or she can adjust your therapy accordingly – don’t drop the whole treatment for some over-the-counter pill.

Types of Prescription Medications

There are a lot of different sleeping drugs out there, varying in their active substances, targeting issues, side-effects and form in which they are consumed. Some of them weren’t even primarily made to fix sleeping problems, but due to some fortunate side-effects, can be prescribed to treat insomnia. Most commonly used drugs can be divided into three groups: Benzodiazepines, Z-drugs and Other medications.

Benzodiazepines

Primarily used to treat anxiety, Benzodiazepines have also found common use in treating sleeping disorders by acting on benzodiazepine receptors in the brain. They belong to the group called Central Nervous System (CNS) depressants and work by decreasing excitability in certain parts of the brain, thus helping reduce both anxiety and insomnia symptoms. Two birds with one stone, now you just have to stock up on these, and you’re good, right? Well, no. Benzodiazepines work best when used for shorter periods, and aren’t as useful for longer-term problems. Partly, this is because your body gets used to the initial dose after two or three weeks, and the drug loses its use. So if you want to keep taking it, you have to keep increasing the dose (which alone is not advisable), and the same thing will happen. This effect is called tolerance.

Also, due to the addictive nature of the medicine – you start relying on it to feel normal. If you stop taking it abruptly after using it for over a month, you will experience withdrawal symptoms. These could be physical (inability to sleep, sweating, tremor, headache, nausea, sensitivity to light), psychological (odd sensations, panic attacks, anxiety, etc.) or both, and often beat the whole purpose of taking the drug in the first place. This can happen with overusing Z-drugs as well, and the symptoms could last up to six weeks after you’ve stopped medicating.

Some commonly used Benzodiazepines are: diazepam, estazolam, temazepam, triazolam, clonazepam, lorazepam, loprazolam.

Estazolam

–          comes in a tablet form, taken orally, usually in 1-2mg dosage

–          treats insomnia

–          helps with falling and staying asleep

–          has dependency potential

–       side-effects may include: headache, drowsiness, dizziness, weakness, constipation, agitation, slowed movements

Estazolam, or ProSom, is supposed to be taken at bedtime, or as needed when experiencing difficulty falling asleep, and isn’t recommended if you know you won’t be able to sleep for longer than  6 hours – even after you have slept the night, chances are you will still have difficulties waking up. Estazolam is not for pregnant women and people with liver problems.

Temazepam

–          capsule form, 15, 7.5, 30, 22.5mg

–          recommended dosage: up to 30mg

–          falling and staying asleep

–          should be taken for 7-10 days

–          possible side effects: nausea, vomiting, drowsiness, headache, fatigue

Another typical Benzodiazepine drug, Temazepam belongs in the hypnotic class, also known under the name Restoril. It’s meant to keep you asleep for at least 8 hours, so don’t be surprised if you wake up a bit disoriented and need some time to shake it off.

Triazolam

–          tablet form, either 0.125 or 0.25mg

–          recommended daily dose: 0.5mg or less

–          treats severe insomnia

–          helps with sleep onset but not with maintenance

–          dependency potential

–          side effects may include: drowsiness, nausea, headaches, lightheadedness, skin tingling, nervousness, problems with coordination

–          more dangerous side effects: rash, hives, itching, difficulty breathing, swelling

Triazolam is used on a short term basis to treat severe insomnia, although clinical studies have shown that it also reduces nighttime wakefulness. Common under the names Halcion, Apo-Triazo, Hypam and Trilam, this drug works by slowing brain activity, thus helping you fall asleep. The maximum dosage is 0.5mg per day, but smaller amounts are usually sufficient. If you experience any of the severe side-effects mentioned above, contact your doctor immediately.

Z-drugs

Zaleplon, zolpidem and eszopiclone/zopiclone are the three medications regularly grouped as Z-drugs because of their Z-names and similar function. They are primarily used to treat insomnia, and although they aren’t structured like Benzodiazepines, they affect the same parts of the brain to induce sleep. Z-drugs carry a slightly lower risk of abuse, but can also lead to dependence if taken for over three weeks, with same potential withdrawal symptoms as with Benzodiazepines. Their most common side-effect is drowsiness – many people reported being less attentive or “feeling like a zombie” while on a Z-drug.

Zaleplon

–          tablets, 5 or 10mg

–          Dosage: up to 20mg

–          helps onset sleep

–          can be addictive

–     some potential side-effects: numbness, loss of appetite, tingling in arms or legs, sensitivity to smell, headache, vision problems

Zaleplon (Sonata) is not indicated for sleep maintenance. It is a hypnotic, shown to help patients fall asleep, and FDA approved its use for up to one month. The recommended dosage is 10mg, for elderly and debilitated patients lower than 5mg. In some countries, Zaleplon is also available as Hegon, Zaplon or Andante.

Zolpidem

–          available in capsules of 5 or 10mg

–          recommended daily dosage: 10mg or less

–          indicated for patients with difficulties falling asleep

–          side effects: dizziness, lightheadedness, headache, drowsiness, fogginess

Commonly sold under the names Intermezzo, Ambien, Ambien CR, and Edluar, Zolpidem is a hypnotic drug that, much like Zaleplon, aids sleep onset issues and not maintenance. If you have troubles staying asleep, this one is not for you. Zolpidem has also been linked to CNS depression and has the potential for abuse.

Eszopiclone

–  comes as a tablet of 1, 2 or 3mg

–  recommended dosage: under 3mg

–  indicated for both sleep onset and maintenance

–  classified as hypnotic

– potential side-effects: headache, pains, unpleasant taste, dry mouth, heartburn, unusual dreams, short-term memory loss, decreased libido

Prior to the introduction of this drug, the FDA didn’t approve using hypnotics for a period longer than one month. Eszopiclone or Lunesta has been shown to be mostly non-habit-forming, although this is still discussed among professionals. This pill is classified as a hypnotic and meant to treat short-term insomnia. Don’t eat foods high in fats shortly before taking it, and make sure you are in bed maximum 30 minutes after. Otherwise, you may experience side-effects. It is not recommended for pregnant women.

Other Medication

Some prescription sleep medications that don’t classify under Benzodiazepines or Z-drugs, but are regularly prescribed to treat insomnia, are Ramelteon and Suvorexant.

Ramelteon’s main distinction from other commonly used sleep meds is that it acts on melatonin receptors in the brain instead of GABA receptors or benzodiazepine receptors. Melatonin is a hormone produced by the pineal gland in our brains that helps maintain a healthy sleep-wake cycle monitored by circadian rhythm, which helps us sleep through the night and wake up in the morning, triggered by daylight. Although still quite new to the market (FDA approved less than two decades ago), Ramelteon has shown to be a very reliable sleep pill without being addictive. One possible side effect is dizziness and recommended daily dosage is 8mg – meaning, one pill a day.

Suvorexant, or Belsomra, is classified as a sedative-hypnotic, but also an orexin agonist, which means it acts on orexin receptors in the brain. The US National Library of Medicine Institute of Health defines orexins as “recently described hypothalamic neuropeptides thought to have an important role in the regulation of sleep and arousal states.” Suvorexant comes in 10mg capsules, with recommended daily dosage being no more than 20mg. Side effects may include diarrhea, nausea, dizziness and dry mouth. It also has a potential for dependency, but lower than with Benzodiazepines or Z-Drugs.

Antidepressants with a sedating effect

We mentioned before that treating secondary insomnia without treating the underlying condition would be unwise. While that is true, there are certain situations where you could (at least temporarily) treat both at the same time, and one of those situations is the combination of depression and insomnia. Namely, some medication widely used to treat depression may help ease insomnia symptoms. These drugs are not FDA approved to treat sleep issues alone, but if insomnia is secondary to depression, using some antidepressants could be beneficial for both conditions. A few of these examples include Amitriptyline, Mirtazapine (Remeron) and Trazodone.

Mixing drugs

In short? Don’t do it.

Mixing prescription medication with over-the-counter medication is extremely dangerous, and mixing two prescriptions is just as bad, if not worse. Especially with something that has to do with your metabolic system, depending on how bad you mess up, it can result in a coma, even death. Your doctor has to be informed of your entire background before prescribing you a new pill. Otherwise, you are putting yourself at great risk.

Mixing drugs with alcohol is a terrible idea as well. When taken together, the sedative effect on your central nervous system is double, and short-term side effects could include:

–          impaired motor function

–          falling asleep while doing something that requires attentiveness, such as driving

–          blackouts

–          cardiac arrest

–          sleepwalking

If alcohol abuse is what induced insomnia in the first place, sleeping pills could be very risky.

Conclusion and Safety Considerations

Reaching for pills may seem easy, but could be very dangerous if not taken seriously. Out of the three groups of prescription medications, older and more tried out ones are Benzodiazepines and some Z drugs, but they can have some milder side-effects like drowsiness, decreased attentiveness or headache.  Perhaps more promising and seemingly less harmful would be Ramelteon, with no dependency risks, or even Suvorexant, but these drugs are still relatively new on the market, and not as vastly tested as the older ones.

There are many medications not highlighted in this article with different variations of traits covered here, but the key is to talk to your doctor and be open to some trial time before you find one suitable for you.

Pills don’t combine with other pills without expert advice, and pills with alcohol – never!

Lastly, if you are pregnant, breastfeeding, or have an existing condition such as kidney disease, arrhythmias, other heart or liver issues, low blood pressure – you might want to reconsider taking sleep medication altogether.

For many of us, the challenge of falling asleep at night becomes particularly acute when an important day looms ahead and we’re in dire need of a restful night. It’s incredibly aggravating to lie in bed, watching the minutes and hours tick by, without being able to succumb to sleep. The struggle feels even more intense knowing we need to rise early, making the inability to fall asleep even less welcome. This often leads to a cycle of anxiety and worry about facing the coming day on too little sleep – a concern that only makes the problem worse. For anyone struggling to meet their sleep goals and wants tips for falling asleep faster, here are a number of strategies that could help in winding down and preparing your body for a restful night.

Don’t Nap During the Day 

It can be quite difficult to resist daily napping, but it is something that you should try if you want to sleep on time in the evening. Many people feel sleepy and tired during the day, and they decide to take a nap so that they can feel better. Of course, daily napping has its benefits, such as improved alertness and well-being. However, according to some studies, excessive, frequent and late napping can affect sleep quality and even contribute to sleep deprivation. If you can’t go through the day without a nap, you should try to limit yourself to a short nap of around 30 minutes, but not in the late afternoon or evening. However, it would be a much better idea to eliminate naps altogether if you want to find out if they are affecting your sleep quality and duration or not. 

Avoid Using Electronic Devices before Bedtime 

Most of us like using our smartphones, watching TV or playing video games before going to sleep, but we are often not aware that this habit can disrupt our sleep patterns. It is vital to keep in mind that the use of electronic devices late at night is horrible for our sleep as they emit blue light. Blue light suppresses the secretion of melatonin, the hormone that regulates sleep-wake cycles. When we watch TV or use a mobile phone, it may be difficult for us to fall asleep and stay asleep. It is the best idea to put away smartphones, laptops, and tablets, and stop using them a couple of hours before going to bed. We need to disconnect all electronics if we want to improve our sleep quality and make sure our bedroom is free of distractions. Unfortunately, many people are addicted to these devices and can’t imagine an evening without using them. If you are one of them, you should at least use a blue light filter. Luckily, many smartphones and tablets have this feature, and thanks to it, the screen light will shift from blue to yellow, which is less likely to disrupt your sleep and keep you awake.  

Avoid Looking at Your Clock 

If you toss and turn at night trying to fall asleep, or you wake up in the middle of the night, one of the worst things that you can do is take a look at your clock. Having troubles falling asleep after waking up at night can be a bit difficult, but it is even worse when we become nervous. Watching the time on the clock pass by while we toss and turn can increase our stress and make it even more difficult to sleep. It is annoying to know that you have limited time for rest, and instead of sleeping, you are just lying there in bed doing nothing. If you want to do yourself a favor, you should hide your clock if you can’t resist looking at it. Don’t wait for too long to do this as over time your body will develop a routine. If you don’t stop it on time, you may find yourself waking up in the middle of the night every single night. 

Adjust the Bedroom Temperature 

Another thing that falls into the category of natural ways to fall asleep faster is adjusting the bedroom temperature. It is not easy to drift off to dreamland if you are too cold or too hot. Temperature preferences vary from person to person, and it is not possible to determine the right bedroom temperature for everyone. However, most sleepers prefer setting their thermostat to between 60 and 75 degrees, as they claim it helps them sleep the most comfortably. Of course, you should experiment a bit and find out what temperature level works best for you, but keep in mind that cooler bedroom can help you drift off to sleep. 

Listen to Soothing Music 

In case you are wondering how to fall asleep when not tired, soothing music can help. Listening to relaxing music can help us fall asleep faster at night, no matter if we are tired or not. Falling asleep to the right music can improve our quality and duration of sleep. However, only soothing music with a slow rhythm helps. Don’t expect to drift off to dreamland listening to heavy metal or rock. Relaxing music helps prepare us for sleep. We feel calmer when we listen to it, it slows our heart rate, breathing, reduces stress and anxiety, and triggers our muscles to relax. These biological changes mirror the changes that our bodies go through when falling asleep, which makes soothing music ideal for sleeping. According to research, listening to relaxing music before bedtime has a positive impact on sleep quality and it can even decrease the symptoms of depression. Also, it can assist in improving acute and chronic sleep disorders.  

Try Different Breathing Exercises 

If you want to know how to get to sleep when you can’t, another very effective solution is deep breathing. Breathing exercises can help us relax and direct our mind away from thoughts and worries that keep us awake. Taking slow and deep breaths can calm down our nervous system, relax us, and prepare our bodies for sleep. Deep breathing also provides relief from anxiety and stress and slows down our heart rate. In case you have troubles drifting off to dreamland because of the stress and different worries, you can choose from several breathing exercises that can help you. The best thing about them is that you can do them anywhere, at any time, and they can provide relief from stress before different important events, such as a meeting or an exam, not just before bedtime. 

Choose Comfortable Bedding 

If you want to get enough quality rest that you deserve, it is essential to be comfortable in bed. If it feels good to be in your bed, you will look forward to it every day. Having the right mattress can have a positive impact on your sleep quality and duration. On the other hand, if it is not comfortable, you may have a hard time drifting off to dreamland. Your mattress should match your needs and preferences. Different firmness levels of mattresses are available on the market, and you should make a decision based on your favorite sleep position, weight, and preferences. If you are a hot sleeper, you should opt for models with excellent cooling features. If you suffer from back pain or neck pain, it is a good idea to get a model with fantastic pressure relieving benefits. The choice of pillows is also vital, and it makes a difference between falling asleep almost immediately and tossing and turning. Pillows have an impact on the sleeper’s comfort, temperature, and neck curve, and you should choose them wisely. Different types of pillows are available with different features. You should also consider getting breathable bed linens if you want to sleep comfortably throughout the night. 

Exercise 

Engaging in physical activity is not only healthy, but it can also help us sleep better at night and fall asleep faster. Exercising increases the quality and duration of shut-eye as it stimulates the production of serotonin in the brain and makes you feel calmer and happier, and decreases the cortisol levels, which is also known as the stress hormone. Exercising during the day will also make you tired, which will reduce the chances of staying up late and not getting enough shut-eye. If you engage in physical activity of moderate intensity every other day, you will sleep better at night. However, it is crucial to choose the right time for exercising. Keep in mind that working out in the morning is the best, whereas working out in the evening is not a good idea as it can keep you awake.   

Limit Caffeine Intake 

Most of us grab a cup of coffee or consume caffeinated beverages to fight tiredness and improve our alertness. We especially need caffeine in the morning, when we get out of the bed and need something to wake us up and prepare for what awaits us during the day. Besides coffee, caffeine can also be found in energy drinks, sodas, cocoa, chocolate, ice cream, and more. It works by blocking sleep-inducing chemicals in the brain, increasing alertness and adrenaline production. When we consume it, it takes us several hours to remove it from our bodies. That’s why consuming foods and beverages that contain caffeine is not a good idea in the evening, and we shouldn’t consume them at least 6 or 7 hours before going to bed. Drinking coffee in the evening interferes with sleep quality and quantity.  

Read a Book 

Reading a book is an excellent option if you need help winding down before bed. It can help you relax in the evening and take your mind off worries and stress. However, you need to be aware that there is a difference between reading a paper book and an electronic book. Reading a paper book in the evening will help you wind down and sleep better, whereas electronic book will do just opposite as these books emit blue light that interferes with the melatonin secretion and makes it hard to fall asleep. If you want to relax and improve your sleep quality, you should try reading a paper book.  

Take a Warm Shower 

Taking a warm shower half an hour to one hour before going to bed can help you fall asleep faster. Our ability to drift off to dreamland depends on our internal temperature, among other things. A hot shower will warm up our body, and stepping into the cooler air once we get out of the bathroom will cause our body temperature to drop precipitously. The rapid decrease in temperature prepares our body for sleep and helps us drift off to dreamland faster.  

Sleep serves as an enchanting power source for our bodies, providing us with a boost of energy for the upcoming day when we manage to get those essential seven to nine hours of sleep each night. However, if your sleep is fragmented, resembling a sequence of brief naps rather than a full night’s rest, you’re missing out on the complete recharge.

Sleep fragmentation occurs in some people, and the problem with them is not falling asleep, that part usually passes without a problem; but staying asleep. People who typically experience it wake up many times during the night, and they have troubles falling back to sleep.

While sleep fragmentation is not classified as a sleep disorder, it is a definite symptom of many of them, including sleep maintenance insomnia, restless leg syndrome, narcolepsy, and more. Lack of sleep also leads to excessive daytime sleepiness and fatigue, morning headaches, impairment of memory, focus, and mood. When fatigue becomes chronic, it can lead to weight gain, elevated blood sugar, high blood pressure, and cardiovascular problems.

Why You Shouldn’t Overlook Sleep Fragmentation

Sleep fragmentation is described as many brief arousals during the night. These are not the typical microarousals that everybody experience during sleep. Microarousals are natural, and they occur during the transitions between sleep cycles. You don’t recall them later, and they don’t cause daytime fatigue.

Sleep fragmentation, on the other hand, involves awakenings that a person can recall in the morning. People who are experiencing them are often struggling to fall back to sleep, which leads to less sleep time and daytime fatigue.

Disrupted sleep is more than just annoying. It can lead to some severe health consequences including weight gain, cardiovascular problems, impaired mood, memory, and concentration. Scientists have observed that a night of fragmented sleep can lead to similar effects as skipping rest. That’s due to the less time spent in the deep restorative stage of sleep.

If you are regularly experiencing sleep fragmentation, you may be suffering from a condition called sleep maintenance insomnia. People who have this condition have no problem falling asleep, but they can’t stay asleep. There is also a condition called sleep onset insomnia, and where people have a problem falling asleep instead of maintaining it.

Experiments on animals have shown that sleep fragmentation can induce tumor growth. Lack of sleep also leads to increases oxidative stress in the brain so that sleep fragmentation can lead to increased insulin production and activation of some mechanisms that serve a protective purpose in brains.

Causes of Fragmented Sleep

Sleep fragmentation isn’t listed as a specific disorder, and while it is relatively common, its exact prevalence is unknown.

There are occasional situations when sleep fragmentation occurs. It can happen when you are feeling ill, and coughing or a sore back is keeping you awake. New parents also experience disrupted sleep, due to many wakings during the night, to care for their newborn. This kind of sleep fragmentation is entirely reasonable, and it doesn’t mean that there is anything wrong with the person. When the disturbances are over, sleep restores to normal.

Fragmented sleep can be a result of a sleep disorder, including sleep maintenance insomnia, restless leg syndrome, sleep apnea, and narcolepsy. Treating these conditions should lead to better sleep quality.

Sleep fragmentation can be a result of daytime habits as well. Poor sleep hygiene, alcohol and caffeine consumption, exercising too close to bedtime, and not timing or napping too much during the day. Improving those habits should restore your sleep to normal.

Some people sleep in two intervals during the night with a long wake period in between. That is not considered fragmented sleep, it is classified as a biphasic sleep, and a lot of people sleep that way.

Sleep Fragmentation Diagnosis

If you are experiencing sleep problems and have decided to visit a sleep specialist, they might use Sleep Fragmentation Index (SFI) to measure the level of sleep disturbances that you experience. The SFI is shown to be a quick and reliable method, and it compares your nighttime awakenings, shifts between sleep stages, and your total sleep time.

A doctor might instruct you to a stay at a sleep facility for an overnight study called polysomnography. Sleep technicians attach you to a bunch of electrodes that track your brain waves, heart and respiration rates, your chest, limb, and eye movement. Besides that, they observe you to see if there is any snoring or some other unusual behavior. Polysomnography is a golden standard when it comes to determining the quality of sleep, and it gives doctors all the information they need about your nightly slumber.

If you are not comfortable staying for an overnight study, they might ask you to keep a sleep diary for a week or two, as well as provide your medical history and medication use. Sleep diaries are easy to maintain, and anyone can do it. You write down different kind of information about your sleep including:

• The time you go to sleep each night
• How much it took you to fall asleep (sleep latency)
• When you wake up in the morning
• If you have experienced any disruptions during the night
• How rested you felt after waking up
• If you have taken any naps during the day
• How energized you were during the day

If that seems a bit complicated, they can also give you a small device that is worn around the wrist, and it tracks your movement and heart rate. This method is called actigraphy, and it is pretty useful in determining whether you are sleeping or not.

All of these methods will provide sleep specialists with enough information to determine the cause of your disrupted sleep and to prescribe you the right treatment.

Sleep Fragmentation Treatment

Treatment for sleep fragmentation usually involves treating any underlying sleep disorder that might be causing it; like narcolepsy, sleep apnea, and restless legs syndrome.

Melatonin supplements can be very useful in getting better quality sleep, and they can be bought over the counter in any pharmacy.

Changing your sleep habits and maintaining good sleep hygiene will improve your sleep quality. You should try doing the following:

• Allow yourself to get tired and sleepy. It means that you should better manage or completely avoid naps. Sleepy people are less likely to experience fragmented sleep.
• Exercise regularly but make sure that you don’t do it to close to bedtime as it can leave you laying in your bed wide awake.
• Set a sleeping routine, and stick with it. It means that you should go to sleep and wake up at the same time every day. Staying late, or sleeping in on weekends can seem like a good idea, but you should only do it if you are sleep deprived, and you need to make up for lost rest.
• Ban all the electronics from your bedroom. Screens emit blue light that can disrupt your circadian rhythms, and it can make it harder for you to fall asleep. That’s why you should remove the TV and laptop from your bedroom, and avoid looking at the screens at least an hour before bed.
• Remove any disturbances from your bedroom. Shut your windows and fix any leaking faucets you have in your home. If you can’t completely block the outside noise, consider using earplugs or white noise machine.
• Besides keeping your bedroom quiet, you should also keep it dark and set the temperature you prefer. Consider getting warmer color light bulbs, get a block out curtains if it’s needed, and pick the right temperature.
• Buy a comfortable mattress, pillow, and bedding. This can drastically improve your sleep, so think about replacing your old or uncomfortable items.
• Avoid drinking caffeine eight hours before bed. You should also avoid nicotine, as those are stimulants and they can keep you up at night and increase the number of nighttime awakenings.
• Avoid drinking alcohol a few hours before bedtime, and also don’t drink too much fluid before going to bed. Too much liquid will make you have to go during the night, and it might be hard to fall asleep afterward. Alcohol stimulates synthesis of a neurotransmitter called vasopressin. More vasopressin means less protein called aquaporin. The primary function of this protein is the transport of water through the membranes of our cells. When there is less aquaporin in our urinary tract, less water will be reabsorbed, and that means that we will have more urine to excrete. That is why drinking beer will make you go to the bathroom so many times.
• Consider getting a sleep tracker. These devices can be pretty useful in giving you some insight about your sleep. Wearable ones also have many more purposes, including fitness tracking, GPS and advice to improve your sleep habits.

Advice for new parents

Having a baby can be very stressful, and worsen the quality of your sleep. There are a few things you can try to get the best rest possible:

• Share night shifts with your partner. Someone can take the first half of the night, and the other can take the second. That way you’ll get some sleep, and be ready for a new day of parenting.
• Turn the baby monitor down. Babies often produce a lot of sleep noises, so responding to every sound won’t be beneficial for you or your baby’s sleep.
• Keep the lights off during nightly diaper changes or visits, as bright light may suppress the production of melatonin, the hormone responsible for your sleep.
• Develop healthy sleeping habits. Ban screens from your bedroom, exercise regularly and make a nice relaxing bedtime routine for yourself after you put your baby to rest.

Should you wonder if pain can contribute to exhaustion or additional health problems, healthcare experts recommend not enduring pain for long durations due to its potential negative effects on our overall well-being. Research indicates that the consequences of pain exceed those related to cancer, heart disease, and diabetes combined. It is estimated that in the United States, about 50 million adults suffer from chronic pain, with nearly 20 million of them facing severe impacts. One of the major outcomes of persisting pain is the lack of sleep, which, consequently, may lead to further health concerns.

In fact, it is a vicious circle of causes and consequences, where chronic pain provokes less sleep, and the lack of sleep aggravates chronic pain syndrome. It can be hard to determine the root of the problem, thus making it difficult to heal.

No matter whether your pain is acute or chronic, you can experience sleep difficulties. However, there is a difference between them. Sharp pain can be sudden and severe, but it passes in a while, whereas chronic pain can last for more than six months and exist independently from the original cause, but it may have lower intensity.

Different Types of Sleep-Related Pain

Different types of pain and complications can impact your sleep.

Chronic Pain

Chronic pain lasts for more than six months and causes more pain on top of the original injury. Some examples of chronic pain include fibromyalgia, arthritis, pinched nerve, lupus, chronic fatigue syndrome, Lyme disease, gout, restless leg syndrome, Raynaud’s syndrome, and vascular pain.

Chronic pain affects your sleep habits in different ways. For example, those who have pinched nerve will have a difficult time finding a position that will not increase this pain. Treating your pain while sleeping depends on many factors, but ultimately, maintaining good sleep hygiene and managing the root of your pain are good practices that can help improve your condition.

Back Pain

Back pain is a common problem among people all over the world. Almost fifty percent of Americans report that they have symptoms of back pain, and the situation is very similar in other countries. The human spine protects the spinal cord, nerve endings and internal organs, provides structural support for the necessary upright posture and helps with movement. When the spine is unhealthy, it cannot perform, and because of that, you experience pain in your back. Individuals who suffer from this problem have pain that radiates down the leg, muscle aches, or pain that gets worse with standing, walking, bending or lifting. These symptoms affect sleep especially if you are sleeping on a mattress that does not provide proper spinal support as it will only increase the pain. If you don’t treat them, they will contribute to sleep deprivation.

Neck Pain

Neck pain happens because of many factors such as the narrowing of the spinal canal, arthritis, or disc degeneration, and it is not limited to the neck. You can experience shooting pains, leg weakness, numbness, or tingling in your limbs. Sleeping with neck and shoulder pain creates discomfort, which can damage your sleep quality. It is not recommended to sleep on your stomach, but if you must, it would be best to use thin and soft pillows. If you don’t want to wake up with a sore neck, the best position is back sleeping, and the best pillows for neck pain are memory foam models.

Hip Pain

Hip issues cause pain in the hip and groin area, while pains that you experience in the upper thigh, outer hip, and buttock area are the resulting ligament, muscle, and other soft tissue problems. The most common cause of hip pain is osteoarthritis that occurs because of joint inflammation. Sleeping with hip pain can make it difficult to find a comfortable position. It is vital to talk to your physician and get adequate pain management medicines and physical therapy. In some cases, a hip replacement or chronic pain rehabilitation programs may be needed. Also, you can try exercises that will strengthen your inner and outer thighs, or opt for a water workout.

Arthritis

Arthritis is a widespread condition that affects over 50 million adults. It comes in more than 100 forms, but it primarily affects the joints. The causes depend on the type of arthritis that you have, but the symptoms involve stiffness, pain, swelling, and decreased range of motion. Age and weight are significant causes of arthritis because your joints get older and weaker as you age or gain weight. Injuries that cause joint damage and infections are also common causes of arthritis, along with genetics. Having arthritis pain will make falling asleep problematic, and certain types of this condition can cause sensitivity to noise, motion transfer and temperature. However, getting more sleep and having good sleep hygiene will alleviate pain from arthritis.

Fibromyalgia

Fibromyalgia is the cause of widespread body pain that comes with other conditions such as arthritis, irritable bowel syndrome, or lupus. Among the symptoms of fibromyalgia are stabbing and shooting pains, severe pain, deep muscular aching, and stiffness. This condition causes sleep disturbances by interrupting your sleep with sudden brain activity that is typical in awakened state. To fight this condition and improve your sleep quality, you need to find ways to get psychological support for chronic pain, therapeutic massage, physical therapy or ways to destress.

Headaches

Researchers have found that every year over 36 million Americans report headaches and migraines. Migraines cause severe head throbbing, blurred vision, nausea, vertigo, fatigue, and light sensitivity. And if you have migraines, you are likely to experience sleep problems for as long as the symptoms last (which can even be days). Individuals that suffer from migraines often have insomnia, so having good sleep hygiene is a helpful way to reduce these problems. Of course, you also need to reduce the consumption of headache-triggering substances, such as coffee and alcohol, and drink plenty of water (just not before bed).

Endometriosis

Women who have endometriosis usually feel pain in the stomach or lower back area during, before or after their menstruation, or even during sexual intercourse. With this condition, irregular or heavy bleeding, along with fatigue and cramping pain, can cause sleep problems. Many treatments can help you with endometriosis symptoms, such as hormonal treatments and laparoscopic surgery. Be sure to consult your doctor before undergoing any procedure or treatment.

REM Pain

Rapid eye movement or REM is the sleep stage where parts of your brain are acting like you are awake. Scientists are still exploring REM sleep, but they have found that it is crucial for memories and dreams. However, REM sleep behavior disorder can cause you to have unpleasant dreams and act out by making noises like shouting, talking, laughing, or cursing or even punching around you. If you have narcolepsy or neurodegenerative disorders, you are more likely to have REM sleep behavior disorder. The same goes if you are taking specific medications or if you are a male over 50. The best treatment would be to take natural or prescription sleep aids that will improve your sleep. You might also want to safeguard things around you.

Pain From a Bad Bed

Having a lousy mattress can also drastically affect your sleep quality, while a good bed can help you. Sleeping on a good mattress can help you reduce pressure points on the shoulders, hips, the lower back region, and neck, alleviate aches and pains, and get proper spinal alignment, while a lousy mattress will increase the pressure on these areas and cause more pain. The weight of your body and the position you sleep in can be vital in finding the ideal mattress material and firmness.

We will now list the primary materials you have on the mattress market.

The most common mattress type is innerspring. These models are bouncier than others, but they are also very firm. Many people have complained that they are too firm, so if you need a firmer mattress, this would be a good choice for you.

Latex mattresses are models that have at least one layer of latex in the comfort area. Because of this structure, they provide excellent pressure relief, pain relief, and spinal support. For better comfort and feel, they can have many layers of latex with different densities. But they do not have edge support so that you can get sinkage around the edges.

Foam mattresses have close conforming to the body, and they provide great alignment for your spine and excellent pressure relief.

Memory foam models have extraordinary pain relief, but heavier people should get firmer models to prevent excessive sinkage.

Airbed mattresses are filled with air. You can deflate them to create a different feel on your body. They effectively absorb motion transfer, but they make noise that can cause some people sleep disruptions.

Hybrids are a combination of two or more components, like innerspring, latex, wool or foam. With their unique combination and structure, they give excellent edge support with minimal sinkage, but they are not a good choice if you need an extra-soft or extra-firm surface.

However, you should note that many companies have sleep trials with their products, so you will be able to try the mattress and find the right fit. Some companies even have trial periods, warranties and refund policies, so it will make choosing the right model cost-free. Be sure to check these details and read some guides before buying a new mattress.

Choosing the Right Pillow

One of the crucial things that should be at the top of your list is selecting the right pillow. The right pillow can aid or worsen your chronic pain. Thickness, material, and loft are vital factors for your choice of pillow. They determine if the pad will alleviate or increase your pain. There are also pillows that are made especially to help with certain chronic illnesses like back or neck pain.

Dealing with Sleep-Related Pain

Studies have suggested that lack of sleep is more likely to predict chronic pain than the other way around. So, it makes good sense to deal with the problem correctly, preventing it to from escalating and transferring to a higher level of health deterioration, since sleep hygiene can impact how we can deal with pain. Below are some of the practices we need to follow for the benefit of our health.

• The proper duration of sleep

It is estimated that adults need about 7 to 7.5 hours of sleep a night, but we don’t have to stick to this firmly. Instead, find out what amount works best for you.

• Time of going to bed

What most of the doctors suggest is to go to bed around 10 p.m. or at least before midnight, which is hard to achieve with the pace of modern life. But, we should definitely go to bed at the same time every night. There are sleep tracker apps we can use to maintain regular sleep habits, so we should profit from these benefits of the modern age.

• Avoiding noise

It is known that sound prevents us from having a quality sleep, so we should opt for a quiet place, or relay on the help of white noise machines to eliminate city noises or other background sounds.

• Proper bedroom conditions

Dark and cool bedroom is best for healthy and peaceful sleep. Just as the light sends a signal to our body that it should be awake and active, darkness helps our body to produce melatonin, a hormone produced in the brain’s pineal gland, often known as the “sleep hormone,” which sends a signal to our mind that it is time for rest. Melatonin influences sleep by sending a signal to the brain that it is time for snoozing, thus preparing our body for sleep by relaxing our muscles and reducing our body temperature.

• The role of bed

The bedroom is an essential part of your home, so it should only be dedicated to sleep, as opposed to what we usually use it for, like watching TV, eating snacks and similar bad habits. As for the walls, even though the colors of walls are subject to trends, they should be chosen with care. For example, light pink colors, shades of mauve, or deep purples, colors with violet undertones are a trend for 2018, but in order to be productive, we should color our bedroom walls blue, yellow, green, silver or orange. Based on the study of 2,000 British homes, Hotel booking site Travelodge concluded that those who slept in a blue bedroom were sleeping around 7 hours and 52 minutes every night because blue is associated with calmness, which reduced their blood pressure and heart rate. Shades of yellow produced 7 hours and 40 minutes of sleep, shades of green produced 7 hours and 36 minutes, shades of silver 7 hours and 33 minutes and shades of orange 7 hours and 28 minutes. So, pick your colors carefully, because your sleep depends on them. The worst colors were proven to be purple, brown and grey.

• Limit screen time

As much as we depend on mobile phones and tablets, these gadgets have no place in bedrooms. The screens trick our brains that it is daytime. Avoid using them an hour before bed.

• Bedtime routine

We are all creatures of habit, so sleeping is no different. Make your own routine by taking a warm bath, using aromatherapy, drinking warm milk or other practice you feel helps you sleep better. There are even some indications a banana helps.

• Living habits

Daytime habits are equally important. Sunshine during the day, eating well, exercising, and simply living a healthy life helps good sleep.

• Forbidden pleasures

Night time is no time for coffee and alcohol. They are stimulants and will not help you get good sleep. So, do not take them four to six hours before going to bed.

• Ultimately, relax

We all faced those moments of frustration lying in bed with eyes wide open. But, getting angry will not help. The best thing to do is to get up and do something relaxing, (such as reading a book) before going back to bed to give it another try.

Over the past decade, there has been a notable increase in research on sleep, primarily thanks to various organizations focused on underscoring the essential importance of sleep.

Unfortunately, despite all effort, it seems that the quality of sleep keeps dropping and sleep disorders become more and more common. Based on the latest survey, over 35 percent of Americans do not get enough sleep; the average number of snoozing is 6.8h. Compared to 1985 there has been an increase of 31 percent when it comes to people who sleep less than six hours.

A fun fact is that a century ago (in 1910) people slept around 9h on average.

Times have changed since then, but we can all agree that the importance of proper rest and sleep hasn’t. That is why many doctors and sleep specialists have decided to develop tests that can help them define disorders and understand them better.

Multiple sleep latency test is one of them.

What is the Multiple Sleep Latency Test?

Multiple sleep latency test is a helpful tool that doctors use to determine a sleep disorder where daytime sleepiness is the leading cause of disrupted sleep. It usually follows Polysomnography or PSG, which is an overnight test that monitors the sleep stages and patterns. PSG test can also help exclude sleep disorders including restless leg syndrome, sleep apnea and others.  

Some doctors decide to include tests like: 

• CPAP titration testing which helps to determine adequate pressure for those who use CPAP machine

• Split Night Study that helps doctors define if the person is suffering from obstructive sleep apnea
• MWT or maintenance of wakefulness test that measures how awake and alerts a person is while being an environment that is free from stimulations.

How Does MSLT Work?

After conducting a PSG, MSLT is scheduled during the day, but the patient must stop consuming antidepressants and stimulants a few weeks before taking the test.

On the day of the MSLT, the patient will have five naps lasting 15-20 min each and 2h apart. The goal of this test is -to see how fast the person will fall asleep during the daytime in an environment that is relaxing and quiet.  

This test also shows when the patient enters the stage of REM sleep. In most cases, people who do not have any disorder will not enter REM sleep while napping for a short time. The stage of REM sleep occurs after more than 1h during the night.

The nap takes place in an environment free from distractions, noise, and stimulations that can prevent them from falling asleep. For Multiple sleep latency test to work, a person must sleep at least 8h the night before, and should not be exposed to strong sunshine and exercise in the morning.

The equipment used for this type of test is similar to the one that is used for PSG. It consists of monitors and electrodes that collect data. Pieces of equipment include:

• Small cup wires attached to the scalp to measure brain activity
• Two elastic belts that go around your stomach and chest to regulate breathing  

• Electrodes with wires attached on your face and chin to follow the activity of the muscles and eye movement. The reason why they are attached to your chin is to follow possible teeth grinding.
• Nasal Cannula and heat monitor
• A microphone small in size to detect possible snoring
• Monitor that follows your levels of oxygen attached to your fingers
• Electrodes attached to your legs to track muscle activity
• EKG to track the rhythm and heart rate  

What Does MSLT Measure?

The primary function of this test is to determine the time people need to transit from awake to sleepy and how fast ones goes into REM sleep. The idea is that people who are sleepy will fall asleep more quickly compared to those with a sleep disorder.

For most people, it takes five to fifteen minutes to go into light sleep, but for people who have narcolepsy and idiopathic hypersomnia, it happens much faster. For patients with narcolepsy, it takes less than five minutes, while those who have idiopathic hypersomnia fall asleep in less than eight minutes.

People who sleep normally REM sleep usually occurs after one hour, and it is the same for idiopathic hypersomnia. But that is where IH and narcolepsy differ from one another. People with narcolepsy fall into REM sleep in less than fifteen minutes.

After the treatment, clinical neurophysiologist or sleep specialist read the results and then send them to the doctor that ordered this kind of test. It can take about two weeks to get the results.  

MSLT Cost

The cost of a multiple sleep latency test can vary depending on the sleep clinic. The ones that some hospitals provide are offering lower expenses compared to the ones in the sleep clinic. The price ranges from 600 dollars to 2200 dollars.

Many professionals respect this test because the results that it provides are consistent, but it does not offer a 100% diagnosis for any disorder mostly because normal sleep latency is yet to be confirmed. But on the other hand, it can provide valuable insight to symptoms of sleep disorders that cause seizures, sleep apnea and distinguish narcolepsy from idiopathic hypersomnia.

Since we mentioned many times PSG test and disorders like narcolepsy and idiopathic hypersomnia, we will provide you with some facts about it.

What is Polysomnography?

PSG or polysomnography is a test that is you take while you are sleeping. A doctor supervises you as you sleep, and record information about the pattern of your sleep and possible symptoms of sleep disorders. These are the things that will be measured:

• Eye movement

• Breathing and heart rate
• Levels of blood oxygen  
• The activity of the skeletal muscles
• Brain waves

Polysomnography notices the shift between non-REM and REM sleep. Non-REM sleep is separated into light and deep sleep. When you are in REM sleep the brain activity is very high. This is also the stage when dreams occur. In non-REM sleep, the activity of the brain is slower. A typical sleeper experiences 4-6 cycles each night.

As the sleep specialist observes your sleeping cycle, possible changes and how your body reacts to them, he/she can detect sleep disruptions and help you identify them.

How Does Polysomnography Work?

Major hospitals or sleep centers offer this kind of testing, and it occurs in the evening 2h before your sleep time (as we mentioned the night before MSLT). Since you will stay overnight, the center will provide you with a room similar to a room in a hotel. Of course, you can bring your own PJ and everything that is essential for your bedtime routine. A specialist observes the patient while sleeping, and because the specialist will hear and see inside the room, you will be able to consult during the night.

In order to measure stated parameters and record them, the specialist will have to put wired electrodes on your scalp, legs, chest, and temples. The sensors have patches that are adhesive so that they won’t fall off during the night and those sensors have thin wires that send information to a computer. Some sleep centers offer a possibility to record a video of that data. That way you and your doctor can review changes in the position of your body during your sleep.

To be fair, you probably won’t feel that comfortable enough to stay asleep as you would back home but don’t worry that won’t affect the results of the test.

Once you wake up the specialist will take off the sensors; you can leave and continue with your daily activities.

What is the Purpose of Polysomnography?

Polysomnography is used to monitor your sleep and determine when and why are your sleep patterns disrupted. During REM sleep,  the waves in your brain slow down drastically based on EEG.

In non-REM stage, your eyes do not move as much but after a few hours the brain waves speed up, and the REM stage begins where most dreams occur. You usually enter many sleep cycles, and a cycle between non-REM and REM takes about ninety minutes, but sleep disorders can disrupt that process.

The doctor might recommend this test if he or she thinks there might be a chance that you have:

• Narcolepsy – If you feel overwhelming daytime drowsiness and experience sudden sleep attacks.
• Sleep apnea – If your breathing occasionally stops during sleep.
• REM sleep behavior disorder – If you start to act out your dreams while you sleep.
• Periodic limb movement disorder – If you move your limbs uncontrollably similar to restless leg syndrome.

• Strange behavior while sleeping – such as sleepwalking or sleep talking
• Chronic insomnia – If you experience difficulty falling or staying asleep.

Idiopathic hypersomnia

This sleep disorder belongs in a category called Central Disorders of Hypersomnolence. The ICSD- 3 explains that most people with this disorder complain that despite regular sleep they feel sleepy during the day. Also, it makes waking up in the morning or after a nap harder.  

The difference between other sleep disorders and hypersomnolence is that other disorders are caused by disruption of sleep while this disorder does not have an external cause. However, even if a person sleeps normally, he or she cannot feel rested or refreshed.

The feeling of being sleepy can occur at any time like at work or while you’re driving which is why idiopathic hypersomnia can be dangerous.

Idiopathic hypersomnia symptoms: 

• Excessive daytime sleepiness
• The difficulty of waking up in the morning despite multiple alarms
• Sleep inertia – a state of feeling confused and disoriented after waking up
• Long naps after which a person doesn’t feel refreshed

• Memory problems and difficulty with attention and concentration.

Difference Between Idiopathic Hypersomnia and Narcolepsy

To understand the difference between IH and narcolepsy, it is best to use the MSLT. The first type of narcolepsy can be distinguished easily because cataplexy is usually linked to it. In the second type of narcolepsy, the cataplexy is non-existent. The multiple sleep latency tests can help understand the difference between those the two.

In people who have idiopathic hypersomnia and narcolepsy, sleep latency happens at a faster pace, but the difference is that narcolepsy patients have a shorter sleep latency of five or less minutes (that is eighty percent shorter than in other people).

Patients that have narcolepsy also have rapid experience of sleep onset REM stage. It is quite common for a person to experience sleep paralysis immediately, but in most cases, narcoleptics go to REM stage in less than 15 min. Unlike the people who have idiopathic hypersomnia have normal sleep onset REM period from seventy to ninety minutes.